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<br />DOILDINC PEAMIT APPLICAT20N C- Lf
<br />,. , . , � 1lpplieant To Comple4e This :orm ' �.���/,��
<br />, ••� Zf oore than one buildinq is to be contructed, submit a separate permit app��SCal �s
<br />•. tloa for each huildin�. �1 separate permit will be issued for each buildinq.
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<br />. " ' Orner i��/f/�L-�y' ./�:u/E'ti Dnildinq Addres� �� " :�AiG���s)�� ��iE;.'
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<br />� � ' o .51 �? , ,i. i�
<br />, ' . �tl3! .'7--�r �/�/L1C/�%� �i-'E,7/Cc= LOC/ � / / [ .
<br />Hlock � /%,�- c�o - •
<br />. ��r �//L-�'��i Phone��-.3�/�( Snbdi4ision (Platl i��%i�ri�e� G �,�nid.
<br />� • �iL,vE L:c 5 G;9•r/Zi��/ � C C� ,S�Si
<br />_ • Jsshitect/Engineer _ .(-%vr��x' • � //1,7�, % �j � �-� ��'�
<br />_.'.�:..`.� City CG�E;iT Phone . .
<br />j Netes F Bounds (Unplatted) �
<br />:.� . , // .
<br />• .. :�'. Caatractor /r�i� �x;��jc��'S ' Sec. Syp, Ry� • _
<br />_ ;..�� 3ddress //ln: a%i .�r�.�.E'�,. . • .
<br />.. ��� CYty .c.S : S%�Z-c'� �S Phone.��5�-:S J� t`% Bnildinq IIse v ib,c• f3C:�.'r" . .. >.:_'
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<br />� State.License N�er 72.� r,/. //z%�,'% �scribe Work to He.Done �it��'`���'"
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<br />: • 1 Lapiration Datt �j �'� '.�-�[:�niniL- it�/T/� �,cniC. �L�'r:�5'
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<br />� � • SICETCH PLOT PLA.N SELOW" • � �c�%'��C j -
<br />� .. -� j • - — �— • � _ .
<br />.i cr�-: ,. Ose of Buildiriq � �. �/�i,+f�
<br />� � ' • • � . ... ' �New ❑ Addition Q Repair/xemo::el
<br />� !' • �� • • • 'Valuation of Construction '
<br />• . . . h . . S �S�
<br />�. ' �• ` : �� - , , , ' � PIAT PLAN REQUI_RE�SEN'fS - .
<br />� , e � . . . ; ; i' .
<br />-'+ � � �=' ' ' Zrdicate lot size, nane of streets,
<br />' ' � � �: .'� ' " 'indicate location and width of
<br />� , �.! � - . ,:� •, � - G , �: • alleys, locate or000sed ar.d a21 � ' �
<br />' ',� ' � ��:• existing buildiags, show dis.ances
<br />' • t'; , ` ' ~';�� � • . to property lines, show distances
<br />.*•l ��. I. ,'� . . ,4 between buildings.
<br />' �t.. ' • ' .
<br />. :. ' ' • .' . , .lj . . � ' . - . . _
<br />� • � �a • �, ' 1 •- � iAt 512C X '
<br />..i- � , � C . . �•• . LoL area �� ,
<br />� `.' : %�CG' Sq. Ft.
<br />. . �.t • f� (h .. ��• � � . Size of Bldq. � , � Sa. Ft.
<br />` � Number of Stories i
<br />' '= ' � ;_ n . • Sasement�.
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<br />,� -� ._- . �I �I Signed By � --o1fPC[t,t 701 . fi�'--n-�
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<br />For ��%/CiLE'�y' ✓�,�iErS'
<br />��-- Owner Phone F; 5� - 5>f:Y
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<br />��� DO :IOT Si:iITE 9�LOt7 TiIIS LI;iE-20R CITY USc� Oi7L'1 � �
<br />_ _ Daie �eceived S��(pl'JT_ Dce�Zone �
<br />' Plan Check :Ju..Ser 7$'�j(p�j ' Fire 2one �-
<br />,valaation 2�—��C,`� � ` '
<br />, Occuoancy Crou�
<br />Pemit Fee {�� '�U Type of Construction `I\r hl
<br />Plan Check Fee %Z• �� Occupant Load •
<br />. ? ibt%i �ee Due i rS �I S� Sprinklcrs Required ' �
<br />, , • CITY Or �
<br />aaee asau�a S1�C,--��7 )� APREZQVE� Ff�R.BUItDING PERMII�
<br />. , . —r'. • ..Dot��� z 1:.--� ,,_yx-�� �_ '
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